More on the money in medicaid expansion debate

Healthcare reform was on the agenda in Gov. Jay Nixon’s 2013 state of the state address as he called upon lawmakers to broaden Medicaid so more Missourians would have access to healthcare. Nixon’s proposed budget includes an expansion of Missouri’s Medicaid program. Estimates are the plan would add nearly 260,000 lower-income adults to the healthcare program through the use of $908 million in federal funds, money that would be received by opting in to the federal Medicaid expansion. In his recent state of the state address, Nixon argued the expansion would create jobs for many Missourians and would bring increased revenue to the state.medi

“Moving forward with this plan will bring a total of $5.7 billion to Missouri for the first three calendar years – at no additional cost to the state,” he said. “The University of Missouri estimates this will generate an additional 24,000 jobs – and that’s just in 2014.”

A second part of Nixon’s proposition is an increase in Medicaid reimbursement rates. Right now, private insurers compensate doctors at a higher rate than Medicaid does. This means doctors make less money if they treat a patient on Medicaid than they would if the patient had private insurance. If the plan is implemented, though, part of the new federal money would be used to compensate doctors, hospitals and other healthcare providers at similar rates. Missouri State Budget Director Linda Luebbering says Nixon hopes the increased revenue would encourage treatment of patients on Medicaid.

“We’re estimating about $1.8 billion in federal funds that will be used to pay healthcare providers – hospitals, doctors, and others – that are providing services to these individuals,” she explained. “So, it’s a big influx of revenue for the healthcare sector – hospitals and doctors and pharmacies and the like.”

Nixon’s plan has encountered opposition, though. State Senator Rob Schaaf, a Republican who represents district 34 near St. Joseph, thinks the plan is a bad idea. He’s a physician by trade, and would stand to benefit from the increased Medicaid reimbursement, but believes the expansion would do more harm than good.

“As a physician, he feels like we do a terrible job of taking care of the folks who are already on Medicaid,” Chris Dunn, his chief of staff, said. According to Dunn, Schaaf believes the current system is broken and believes that because the proposed job increase wouldn’t add enough jobs to the healthcare sector, expansion is counterproductive.

“We don’t have enough primary care physicians and nurses to take care of the new population that will come on board in 2014,” Dunn said. “That’s an issue for the state of Missouri that he has a problem with.”

Additionally, he suggested not everyone who will be privy to the Medicaid expansion necessarily deserves to be included.

“It would be a huge chunk of those new, 250,000 people on Medicaid that are able-bodied, and we don’t feel like adding them to the welfare rolls of the state is beneficial to the state,” he continued.

The Missouri General Assembly’s session started on Jan. 9 and runs through May. It is unclear whether the legislature plans on adopting Nixon’s reform.